Zeitschrift für Nephrologie und Therapeutik

Pulse Wave Analysis in Children with Glomerulopathies

Abstract

Maria Roszkowska-Blaim *,Piotr Skrzypczyk ,Zofia Wawer

Sympathetic activation, hypertension, hyperlipidemia, and immunosuppressive treatment are risk factors for vascular damage in children with glomerulopathies.

Aim: To perform pulse wave analysis in children with glomerulopathies.

Material and Methods: We studied 33 children (22Ã?¢Ã?â?¢Ã?â??, 11Ã?¢Ã?â?¢Ã?â?¬) aged 13.3 ± 3.9 years with glomerulopathies: Henoch-Schonlein nephropathy 9 patients, IgA nephropathy 7 patients, membranoproliferative glomerulonephritis 4 patients, mesangioproliferative glomerulonephritis 3 patients, minimal change disease 3 patients, focal segmental glomerulosclerosis (FSGS) 3 patients, and other nephropathies 4 patients. We evaluated age at the disease onset, development of hypertension, body mass index (BMI) Z-score, selected biochemical variables, glomerular filtration rate (ac. to Schwartz formula), and pulse wave parameters determined using a SphygmoCor device (AtCor Medical, Australia): aortic systolic pressure (AoSP), diastolic pressure (AoDP) and pulse pressure (AoPP), augmentation pressure (AP), augmentation index (AIx), augmentation index corrected for heart rate of 75 beats per minute (AIx-75HR) [%], and an index of myocardial oxygen supply and demand, subendocardial viability ratio (SEVR) [%]. The control group included 20 healthy children matched for age and gender.

Results: Children with glomerulopathies showed trends for higher mean AP (P=0.08) and AIx (P=0.07), and a significantly higher mean AIx-75HR (P<0.05). Patients with hypertension (n=13) showed higher mean AoDP (P<0.05) and AIx-75HR (P<0.05) compared to normotensives (n=20). Six (18.2%) overhydrated patients had significantly (P<0.05) higher diastolic peripheral and aoritc diastolic blood pressure, as well as aortic systolic blood pressure than 27 (81.8%) normovolemic children. In 33 children, AoSP and AoDP correlated positively with proteinuria (r=0.44, P<0.05; and r=0.57, P<0.05, respectively); AoDP showed negative correlations with albumin (r=-0.42, P<0.05), total protein (r=- 0.36, P<0.05), calcium level (r=-0.47, P<0.05). AoPP correlated positively with BMI Z-score (r=0.43, P<0.05), and SEVR negatively with total cholesterol level (r=-0.43, P<0.05).

Conclusions: i. Patients with glomerulopathies show increased arterial stiffness compared to their healthy peers. ii. In children with glomerulonephritis, hypertension is a risk factor for increased aortic stiffness, and hypercholesterolemia may be a risk factor for future myocardial ischemia. iii. Overhydration in children with glomerulonephritis can increase peripheral and central blood pressure without influencing arterial stiffness.